- CVS Health (Tallahassee, FL)
- …it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days ... UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience with LTAC, skilled rehab,… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Director of Utilization Review is responsible for overseeing all utilization review activities to ensure that clients receive ... of care for each client. This individual leads a team of utilization review specialists and works closely with clinical, admissions, and billing departments to… more
- Prime Healthcare (Garden Grove, CA)
- …with health information management staff, coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission ... both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Works...Health and Human Services field is highly preferred. 2. Utilization Review /Case Management experience is highly preferred.… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- * Remote in Hampton Roads* Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies ... a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical information… more
- AdventHealth (Altamonte Springs, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. 2) ... better. **Shift** : Full-time; Monday -Friday **Job Location** : Remote **The role you will contribute:** The role of...**The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Novant Health (Winston Salem, NC)
- Job Summary The Utilization Review Clinician serves as a leader resource in the Utilization Review process for Behavioral Health acute care . They ... coordinates and conducts initial, concurrent, and retrospective medical necessity reviews. All Utilization Review activities are performed in accordance with the… more
- AmeriHealth Caritas (Dover, DE)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Children's Hospital Boston (Boston, MA)
- …(Discharge Planning and or Utilization Management) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem Remote Eligibility :Onsite Only ... 79378BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:79378BRStatus:Part-TimeStandard Hours per Week:1… more
- Centene Corporation (Olympia, WA)
- …related to member care, provider interactions, and facilitates operations within utilization management. + Manages prior authorization, concurrent review , and ... organization offering competitive benefits including a fresh perspective on workplace flexibility. ** Remote role with candidate needing to reside in MST or PST time… more
- Ochsner Health (New Orleans, LA)
- …(2) Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty ... Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment to apply for such certifications +… more
- Centene Corporation (Phoenix, AZ)
- …this remote position.** **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Monroe Plan for Medical Care (Albany, NY)
- …HAS DIRECT REPORTS:NoESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function 75 Utilization Review Functions Perform utilization review ... to work independently.-Strong organizational skills.-Strong computer and typing skills PREFERRED: -Prior Utilization Review or Case Management preferred. more
- LifeCenter Northwest (Bellevue, WA)
- Organ Utilization Coordinator Job Details Job Location Bellevue - Bellevue, WA Position Type Full Time Salary Range $75918.00 - $110112.00 Salary Job Posting Date(s) ... Start Date 04/09/2025 Description and Qualifications The Organ Utilization Coordinator (OUC) is accountable for overseeing all activities related to the allocation… more
- Ochsner Health (Lafayette, LA)
- …+ Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains employee ... in and will work from the following areas are not eligible for remote work position_ _: Colorado, California, Hawaii, Illinois, Maryland, Minnesota, New York,… more
- Humana (Frankfort, KY)
- …and help us put health first** The Manager, Behavioral Health Utilization Management uses clinical knowledge, communication skills, and independent critical thinking ... department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for supporting **_Behavioral… more
- Baptist Memorial (Meridian, MS)
- Overview Possibility for remote . Prefer UR Experience with varying clinical background, organizational skills, and ability to work independently. REQNUMBER: 31009